Gregory Law Group Class Action: Weight Loss Surgery
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Name *
Current Address (City and State) *
Phone Number *
Current Age
Date of Birth
MM
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DD
/
YYYY
Email Address *
What state you were living in when surgery took place
Surgeon
Surgery Location
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Procedure
Surgery Location
Recovery Location in Mexico
Who referred you to the Mexican surgeon
Symptoms you have experienced since surgery
List of major complications
Please tell us your story
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